WASHINGTON — A key Democrat released the much-awaited Senate version of an American health care system remake Wednesday— a landmark $856 billion, 10-year measure that starts a rough ride through Congress without visible Republican backing for President Barack Obama's top domestic priority.
The bill by Sen. Max Baucus, chairman of the Finance Committee, would make major changes to the $2.5 trillion U.S. health care system, including requiring all individuals to purchase health care or pay a fine, and language prohibiting some insurance company practices like charging more to people with more serious health problems.
Baucus' proposal has drawn no visible backing from Republicans. But Baucus said he is holding out hope that some will support the plan when his committee votes on the bill, probably as early as next week.
His proposal has been eagerly anticipated because, of several bills being considered in Congress, it is seen as the only one that could get support from Republicans as well as Democrats.
Obama had campaigned on a pledge of bipartisanship and has said he wants to reach a compromise with Republicans on a health care package. Liberal Democrats, though, doubt Republicans can be persuaded to support any agreement and want Obama to use his party's strong majorities in both chambers to push through legislation.
But it is not clear that he has the votes to do so. Democrats are now one vote shy of the 60 votes they need to block Republican efforts to derail the bill in the Senate. Also, with congressional elections approaching next year, some Democrats from conservative states are wary about supporting an overhaul that voters may see as too liberal.
That means Baucus' plan may offer Obama his best hope for getting health care legislation passed. The final version of the bill — if one gets passed — could be shaped more by Baucus' plan than by the proposals of any other lawmaker.
"This is a unique moment in history where we can finally reach an objective so many of us have sought for so long," Baucus said. "The Finance Committee has carefully worked through the details of health care reform to ensure this package works for patients, for health care providers and for our economy."
Consumers would be able to shop for and compare insurance plans in a new purchasing exchange and caps would be placed on patients' yearly health care costs. The plan would be paid for with $507 billion in cuts to government health programs and $349 billion in new taxes and fees, including a tax on high-end insurance plans and fees on insurance companies and medical device manufacturers.
The bill fails to fulfill Obama's aim of creating a new government-run insurance plan — or option — to compete with the private market. It proposes instead a system of nonprofit member owned cooperatives, somewhat akin to electric co-ops that exist in many places around the U.S. That was one of many concessions meant to win over Republicans.
In other ways, though, including its overall cost and payment mechanisms, the bill tracks closely with the priorities Obama laid out in his speech to Congress last week.
The bill represents the most moderate health care proposal in Congress so far, compared to legislation approved by three committees in the House of Representatives and the Senate's health panel. Obama's top domestic priority is to revamp the health care system to provide coverage to nearly 50 million Americans who lack it and rein in rising costs.
The United States is the only major industrialized country without a comprehensive health care plan to cover costly medical bills. Most Americans have private insurance provided by their employers and some buy their own policies. The government covers the elderly, disabled, indigent and some veterans.
Democratic leaders are aiming for votes in the full House and Senate later this year.